Duration of Systemic Hypertension Linked to Retinal Vessel Density Loss

Systemic hypertension poses increasing risks of coronary heart disease, stroke and organ dysfunction, including changes in microcirculation. Researchers recently hypothesized that longer durations of hypertension would result in significant reductions in vessel density across various retinal layers and enlargement of foveal avascular zone (FAZ) parameters, linked to measurable changes in visual field indices. The findings of their recent small study confirmed this using OCT angiography (OCT-A), suggesting that this diagnostic tool could be used to monitor hypertensive damage to ocular health.  OCT-A may be used to monitor systemic hypertension, researchers argued, as they found a strong association between the condition and OCT-A-derived vessel density—especially in the deep capillary plexus—resulting in a measurable decrease in visual field indices. This figure from the study shows a 53-year-old man with hypertension of 10 years’ duration with apparent reduction in the microvasculature in the superior region and corresponding inferior and paracentral visual field defects. Photo: El-Maghrabi SMM, et al. BMC Ophthalmol. November 21, 2025. Click image to enlarge. The prospective, observational, case-control study involved 68 participants, consisting of 34 individuals diagnosed with systemic hypertension and 34 healthy controls. Participants in the hypertensive group were categorized based on the duration of their condition: Group 1 comprised 16 patients who had hypertension for less than five years, while Group 2 included 18 patients with hypertension lasting more than five years. Each participant underwent visual acuity assessment, OCT-A imaging and perimetry using the Humphrey Field Analyzer.Results indicated a significant reduction in vascular density for hypertensive patients compared to controls, particularly pronounced in Group 2, which exhibited reductions in vascular density of 18.4% in the superficial capillary plexus (SCP) and 20.1% in the deep capillary plexus (DCP). Additionally, the FAZ area was significantly larger in hypertensive patients, especially in the DCP layer. Moreover, Group 2 patients with longer hypertension duration had significantly reduced inferior choriocapillaris vessel density and more visual field defects.In their paper on the findings, published last week in BMC Ophthalmology, the researchers stated, “An association between development of visual field defects and longer duration of systemic hypertension was demonstrated, suggesting that there is a correlation between OCT-A retinal vascular parameters in different layers with visual field parameters.” Regarding the implications for clinical practice, they argued, “Both OCT-A and visual field examination could be used as a potential tool for the follow-up of systemic hypertension end-organ damage.” Limitations of this study include its cross-sectional design and modest sample size, potential segmentation errors and insufficient adjustment for systemic comorbidities like diabetes and dyslipidemia, as well as lifestyle factors such as smoking, known to affect choroidal vasculature. Additionally, the impact of various antihypertensive drug classes on the results was not fully accounted for.“Future research should employ longitudinal designs, larger samples, multimodal imaging and stratification by medication type to better elucidate the relationship between systemic hypertension, retinal microvasculature and visual function,” the authors concluded. Click here for the journal source. El-Maghrabi SMM, Ghazawy RMFE, Dayem HMKA, et al. Evaluating the effect of systemic hypertension on retinal, optic nerve head microvasculature and field of vision using optical coherence tomography angiography and visual field analyzer. BMC Ophthalmol. November 21, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.